Rectus sheath hematoma (RSH) is an uncommon but well-documented clinical condition. It is usually caused by direct trauma or anticoagulation, although there are many other causes. However, RSH after noncontact strenuous exercise is very rare. We present a rare case of RSH after playing volleyball without direct trauma that was successfully treated by angiographic embolization.Keywords: Abdominal wall; Sports; Angiography
INTRODUCTIONRectus sheath hematoma (RSH) with inferior epigastric artery injury is an uncommon but well-documented clinical condition [1]. It is usually associated with abdominal trauma or anticoagulation. Other causes of RSH include abdominal surgery, old age, asthma, coughing, and subcutaneous drug injection into the abdomen [2]. Some cases of RSH due to direct trauma or other causes have been reported, but very few for RSH caused due to noncontact strenuous exercise. We present a rare case of RSH after playing volleyball without direct trauma in a healthy individual.
CASE REPORTA 41-year-old woman with right lower quadrant abdominal pain presented to the emergency department. She had experienced abdominal pain after playing volleyball a week previously, which soon resolved with rest. But, the pain recurred after spiking the ball while playing volleyball on the day of admission. The pain aggravated by strengthening her abdomen and subsided with rest. There was no history of direct abdominal trauma. She had no medical history and was not on any medication. Her vital signs were stable: blood pressure, 110/60 mmHg; pulse rate, 87 beats/min; respiratory rate, 16 breaths/min; and body temperature, 36.2°C. Physical examination revealed tenderness and a palpable mass in the right lower quadrant of the abdomen. Laboratory data, including hemoglobin levels, in the normal range. Computed tomography (CT) revealed a 6×4×18 cm rectus sheath hematoma with extravasation in the right lower rectus abdominis muscle (Fig.